06.02.2015 Views

M A S T E R B A T C H - Gala Industries

M A S T E R B A T C H - Gala Industries

M A S T E R B A T C H - Gala Industries

SHOW MORE
SHOW LESS

Create successful ePaper yourself

Turn your PDF publications into a flip-book with our unique Google optimized e-Paper software.

REGISTRATION FORM<br />

Masterbatch 2011, 7-9 June<br />

The Imperial Riding School Vienna, a Renaissance Hotel, Vienna, Austria,<br />

Ungargasse 60, Vienna 1030, Austria<br />

Company:_____________________________________________________<br />

Address: _______________________________________________________<br />

____________________________________________________________ __<br />

______________________________________________________________<br />

Country:_ ______________________________________________________<br />

Tel:_________________________ Fax:_ ______________________________<br />

e-mail address:_ _________________________________________________<br />

VAT No.:__________________________________________________<br />

(must be completed by all EU Companies)<br />

Company activity: _ ______________________________________________<br />

Invoice address (if different from above ):_____________________________<br />

________________________________________________________<br />

________________________________________________________<br />

DELEGATE DETAILS / TABLE TOP DELEGATE:<br />

(If more than one delegate please photocopy form)<br />

Title:________ First name:_________________________________________<br />

Surname:_______________________________________________________<br />

Position:_______________________________________________________<br />

Special dietary requirements: _ _________________________________<br />

PAYMENT DETAILS<br />

All payments to be made in Euros<br />

Early bird discount (990 if you register before the 15th April 2011<br />

Delegate fee @ (990 ___________<br />

(until 15th April 2011)<br />

Delegate fee thereafter @ (1100 ___________<br />

Exhibition package @ (2750 ____________<br />

(includes one free delegate place)<br />

Conference dinner @ (100 ___________<br />

(per person)<br />

Total: ___________<br />

Method of payment<br />

On receipt of this registration form your credit card will be debited.<br />

You will be sent an invoice in 5 working days.<br />

q<br />

q<br />

Bank Transfer quoting : ‘Applied Market Information Ltd.<br />

- Masterbatch 2011’ to: Commerzbank,<br />

Filiale Düsseldorf, Breite Straße 25, 40213 Düsseldorf, Germany<br />

Account number: 1024710 Bank No. 300 400 00<br />

IBAN: DE93 3004 0000 0102 4710 00 SWIFT: COBADEFFXXX<br />

Visa / Mastercard / Eurocard / JCB<br />

(Please note all card payments will be processed in £ Sterling)<br />

- - -<br />

Name of cardholder: _ ____________________________________________<br />

Expiry date:______________________ 3- digit security code:_____________<br />

Cardholder’s signature:___________________________________________<br />

Signature: ________________________ Date:_________________________<br />

Fax back to +44 (0)117 311 1534

Hooray! Your file is uploaded and ready to be published.

Saved successfully!

Ooh no, something went wrong!